Ogura Riyo, Hiasa Yoshikazu, Takahashi Takefumi, Yamaguchi Koji, Fujiwara Kensuke, Ohara Yoshikazu, Nada Teru, Ogata Tatsuro, Kusunoki Kanji, Yuba Kenichiro, Hosokawa Shinobu, Kishi Koichi, Ohtani Ryuji
Division of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan.
Circ J. 2003 Aug;67(8):687-90. doi: 10.1253/circj.67.687.
The clinical course of 'Takotsubo' cardiomyopathy closely resembles that of acute myocardial infarction (AMI) and coronary angiography (CAG) is usually performed to distinguish the 2 conditions during the acute phase. The present study was designed to determine whether the standard 12-lead electrocardiogram (ECG) findings could help to distinguish 'Takotsubo' cardiomyopathy from anterior AMI. The study group comprised 13 patients with 'Takotsubo' cardiomyopathy and 13 consecutive patients with anterior AMI. Patients with 'Takotsubo' cardiomyopathy had abnormal Q waves less frequently than patients with anterior AMI (15% vs 69%, p=0.008). No reciprocal changes were seen in the inferior leads in patients with 'Takotsubo' cardiomyopathy (p=0.0003). The ratio of ST-segment elevation in leads V(4-6) to V(1-3) (SigmaSTeV(4-6)/V(1-3)) was significantly higher in patients with 'Takotsubo' cardiomyopathy (1.55+/-0.53 vs 0.57+/-0.58, p=0.0004). The QTc interval was significantly longer in patients with 'Takotsubo' cardiomyopathy. The absence of reciprocal changes, absence of abnormal Q waves, and a SigmaSTeV(4-6)/V(1-3) >/=1 all showed a high sensitivity and specificity for diagnosing 'Takotsubo' cardiomyopathy. Furthermore, the combination of the absence of reciprocal changes and a SigmaSTeV(4-6)/V (1-3) >/=1 had a greater specificity (100%) and overall accuracy (91%) than either criteria. Therefore, the standard 12-lead ECG on admission can help to distinguish 'Takotsubo' cardiomyopathy from anterior AMI.
“章鱼壶”心肌病的临床病程与急性心肌梗死（AMI）极为相似，急性期通常需进行冠状动脉造影（CAG）以鉴别这两种情况。本研究旨在确定标准12导联心电图（ECG）表现是否有助于鉴别“章鱼壶”心肌病与前壁AMI。研究组包括13例“章鱼壶”心肌病患者和13例连续的前壁AMI患者。“章鱼壶”心肌病患者出现异常Q波的频率低于前壁AMI患者（15%对69%，p = 0.008）。“章鱼壶”心肌病患者下壁导联未见对应性改变（p = 0.0003）。“章鱼壶”心肌病患者V（4 - 6）导联与V（1 - 3）导联ST段抬高比值（SigmaSTeV(4 - 6)/V(1 - 3)）显著更高（1.55±0.53对0.57±0.58，p = 0.0004）。“章鱼壶”心肌病患者的QTc间期显著更长。无对应性改变、无异常Q波以及SigmaSTeV(4 - 6)/V(1 - 3)≥1对诊断“章鱼壶”心肌病均显示出高敏感性和特异性。此外，无对应性改变与SigmaSTeV(4 - 6)/V(1 - 3)≥1相结合具有比单一标准更高的特异性（100%）和总体准确性（91%）。因此，入院时的标准12导联ECG有助于鉴别“章鱼壶”心肌病与前壁AMI。
